Semen Loss Research Articles

The varied presentations of dhat syndrome

Dear Sir, I read with interest the paper titled ‘dhat syndrome, an emergent condition within urology in Spain’ published in your journal on July 27, 2012 (Epub ahead of print), by Menendez and colleagues [1]. The authors described a study on patients seeking urologic consultation with complaints of loss of semen. They have described on two occasions that there was no suggestion of depression in any of these patients. However, there is no mention of any standard questionnaire or scale being applied, or of a psychiatry consultation being taken to confirm the same. Given that 32 patients complained of loss of semen and authors report that none of them suffered from depression is hard to accept. It only reflects the fact that depression was not actively looked for as various studies have suggested depression to be the commonest comorbidity and figures varying from 40 to 66 % have been quoted [2–4]. Similarly, a number of other psychiatric disorders such as anxiety and somatoform disorders might have been missed. This is particularly important because in patients with comorbid depression, antidepressants and other measures aimed at treating depression might have a significantly greater role than those without comorbid depression. Mere education regarding the misconceptions might not help those with comorbid depression and may unnecessarily prolong their misery. This issue is especially important keeping in mind the aim of the authors while publishing the paper. The authors have said that the purpose was to bring to the notice of urologists the existence of dhat syndrome in Spain. In this context, it is important not to send this wrong message. Rather, the message to be driven home is to actively look for psychiatric comorbidity, particularly depression and to judiciously use antidepressants and other measures used in the treatment of depression wherever necessary. The other issue was regarding the definition of dhat syndrome. Although several authors consider loss of semen in urine as dhat syndrome, a number of others consider loss through any route [5]. In this context, patients with loss of semen during masturbation constitute a significant subset. Many of them might present with vague somatic, urologic or sexual symptoms requiring urologic consultation in the absence of complaints of passage of semen in urine. This history of masturbatory guilt is often not spontaneously reported and may not be elicited unless specifically asked for. This information was perhaps not collected from the study sample and has not been highlighted in the discussion or conclusions. Again, keeping in mind the purpose of the paper, this is another important message to be conveyed to the readers.

Cultural misconceptions and traditional healing practices for sexual problems: a mental health perspective

The belief that semen loss is dangerous and harmful for sexual and physical health is widely prevalent and it dates back for hundreds of years. Faith healers, quacks and self-acclaimed sex specialists have been conducive in reinforcing these myths and sexual misconceptions. Faith healing effectively delays medical intervention as well as possibly precipitating other psychiatric complications. We report a case of an adolescent in whom traditional healing practices were traumatizing and precipitated obsessive compulsive disorder.

Dhat syndrome, an emergent condition within urology in Spain

Dhat syndrome (DS) consists of vague somatic symptoms and at times sexual dysfunction which the patient falsely attributes to involuntary emissions of semen outside of sexual relations. Describe and analyse the occurrences of DS in patients attending the clinic and clarify the existence of this condition within the Spanish Urological service. Patients reporting semen loss in urine or involuntarily outside of sexual relations were studied during a period from May 2006 to December 2007. Variables of age, nationality, marital status, family situation, medical history, reasons for the consultation, physical condition and additional tests were studied. All treatments and its effectiveness were also recorded. DS affected predominantly southern Asian continent citizens (n = 32). The average age was 35.44. Seventeen patients reported semen loss during urination; 20 at the end of urination; 11 spontaneously; 5 while sleeping; 4 during defecation; 1 while showering; 1 while eating meat; and 3 produced by noticing stained clothing. In 28 cases, the supposed loss of semen was linked to sex-related symptoms. All examinations and tests ruled out the existence of actual loss of semen. In urology consultations, we have been witnessing the unusual appearance of DS, a condition known by psychologists and psychiatrists and practically unheard of by urologists. A previously unknown condition in Spain, immigration from Asia, is causing the appearance of this syndrome. Its rapid identification will prevent patients from paying costly and unnecessary tests and provide alternative therapies, within a multidisciplinary approach involving psychologists and psychiatrists.

An Unusual Presentation of Dhat Syndrome

An Unusual Presentation of Dhat Syndrome

Development of cognitive-behavioral therapy intervention for patients with Dhat syndrome

Dhat syndrome is a culture-bound syndrome prevalent in the natives of the Indian subcontinent characterized by excessive concern about harmful consequences of loss of semen (ICD-10). Treatment offered to the patients suffering from it continues to be esoteric, unstructured and without standardization. The present study aimed to develop and examine the feasibility of Cognitive – Behavior Therapy module for patients with Dhat syndrome. A draft module was developed based on existing theoretical knowledge and suggestions from five mental health professionals. This module was then applied on five patients with Dhat syndrome to assess and judge the suitability of the module. The pre and post-assessments were carried out using Sexual Knowledge and Attitude Questionnaire - II, Hamilton Depression Rating Scale, The Cognitive-Somatic Anxiety Scale, Screener for Somatoform Disorder, International Index for Erectile Function, Clinical Global Impressions, The World Health Organization Quality of Life Assessment - BREF. Experiences and insights gained from each patient were used to refine the module before applying on the next patient. The final module consisted of the following components was developed: Basic sex education, cognitive restructuring, relaxation training, imaginal desensitization, masturbatory training as homework and Kegel's exercises and ‘start-stop technique’ and ‘squeeze technique’ for sexual dysfunctions. Results of the study reveal that it is feasible to carry out the CBT module in clinical settings. Number of sessions ranged from 11 to 16 sessions. The duration of the session was 45 minutes on the average. Findings of the present study revealed improvement in sexual knowledge, anxiety, depressive and somatic symptoms. Implications and limitations of the study are highlighted and suggestions for future research offered.

Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India

Objectives:To assess the myths, beliefs and perceptions about mental disorders and health-seeking behavior in general population and medical professionals of India.Materials and Methods:A cross-sectional study was carried out with a sample of 436 subjects (360 subjects from urban and rural communities of Delhi and 76 medical professionals working in different organizations in Delhi). A pre-tested questionnaire consisting items on perceptions, myths, and beliefs about causes, treatment, and health-seeking behavior for mental disorders was used. The collected data were statistically analyzed using computer software package Epi-info. Appropriate tests of significance were applied to detect any significant association.Results:The mental disorders were thought to be because of loss of semen or vaginal secretion (33.9% rural, 8.6% urban, 1.3% professionals), less sexual desire (23.7% rural, 18% urban), excessive masturbation (15.3% rural, 9.8% urban), God's punishment for their past sins (39.6% rural, 20.7% urban, 5.2% professionals), and polluted air (51.5% rural, 11.5% urban, 5.2% professionals). More people (37.7%) living in joint families than in nuclear families (26.5%) believed that sadness and unhappiness cause mental disorders. 34.8% of the rural subjects and 18% of the urban subjects believed that children do not get mental disorders, which means they have conception of adult-oriented mental disorders. 40.2% in rural areas, 33.3% in urban areas, and 7.9% professionals believed that mental illnesses are untreatable. Many believed that psychiatrists are eccentric (46.1% rural, 8.4% urban, 7.9% professionals), tend to know nothing, and do nothing (21.5% rural, 13.7% urban, 3.9% professionals), while 74.4% of rural subjects, 37.1% of urban subjects, and 17.6% professionals did not know that psychiatry is a branch of medicine. More people in rural areas than in urban area thought that keeping fasting or a faith healer can cure them from mental illnesses, whereas 11.8% of medical professionals believed the same. Most of the people reported that they liked to go to someone close who could listen to their problems, when they were sad and anxious. Only 15.6% of urban and 34.4% of the rural population reported that they would like to go to a psychiatrist when they or their family members are suffering from mental illness.Conclusion:It can be concluded from this study that the myths and misconceptions are significantly more prevalent in rural areas than in urban areas and among medical professionals, and the people need to be communicated to change their behavior and develop a positive attitude toward mental disorders so that health-seeking behavior can improve.

'Semen contains vitality and heredity, not germs': seminal discourse in the AIDS era.

Perspectives of public health generally ignore culture-bound sexual health concerns, such as semen loss, and primarily attempt to eradicate sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Like in many other countries, sexual health concerns of men in Bangladesh have also received less attention compared to STIs in the era of AIDS. This paper describes the meanings of non-STI sexual health concerns, particularly semen loss, in the masculinity framework. In a qualitative study on male sexuality, 50 men, aged 18-55 years, from diverse sociodemographic backgrounds and 10 healthcare practitioners were interviewed. Men considered semen the most powerful and vital body fluid representing their sexual performance and reproductive ability. Rather than recognizing the vulnerability to transmission of STIs, concerns about semen were grounded in the desire of men to preserve and nourish seminal vitality. Traditional practitioners supported semen loss as a major sexual health concern where male heritage configures male sexuality in a patriarchal society. Currently, operating HIV interventions in the framework of disease and death may not ensure participation of men in reproductive and sexual health programmes and is, therefore, less likely to improve the quality of sexual life of men and women.

P02-300 Dhat syndrome: A systematic review

Background:Dhat syndrome is a widely recognized clinical condition from the Indian subcontinent characterized by a preoccupation with semen loss in urine and other symptoms such as fatigue or depressed mood. This condition has been considered to be a culture-bound syndrome, and may be considered to be a culturally manifestation of depression or anxiety.Aims:The purpose of this paper was to perform a systematic review of published literature on Dhat syndrome.Methods:A review of the literature on Dhat syndrome until July 2008, without any language restriction was conducted by a search of the MEDLINE and PsycLIT indexing services using the following key words:Dhat syndrome, semen loss anxiety and loss of semen syndrome. Inclusion criteria were any case-control or cross-over study.Results:Twenty-three studies were identified, of which 10 met the inclusion criteria. There were 8 cross-over and 2 case-control studies. The reviewed studies included a total number of 680 cases and 93 controls. Patients included in these studies were mostly unmarried, young males (25.4 years old;18-45 years) from a poor socio-economic status. Majority of the studies involved patients from the Indian subcontinent. Some studies reported concomitant depressive symptoms (50%), anxiety (40%), fatigue (30%) and sexual problems (40%). Only 4 studies reported information about treatment (psychotherapy and pharmacotherapy).Conclusions:There was a high degree of heterogeneity among the studies reviewed. In conclusion, Dhat syndrome appears to be commonly associated with depression, anxiety and somatic symptoms. More studies are warranted related to the various treatment approaches for this condition.

Depression in Dhat Syndrome

Dhat syndrome is a widely recognized clinical condition in the Indian subcontinent characterized by excessive preoccupation with semen loss as the main presenting complaint. This condition has been considered to be a culture-bound syndrome, and depressive symptoms have previously been reported. We were interested to know how common depression is, and to quantify these features. We studied 30 patients attending the Psychiatry Outpatient Department of a tertiary care hospital for their complaints about passing of semen in urine frequently. Those with depressive symptoms were further evaluated using the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Diagnostic Criteria for Depression, and depression severity was assessed using the 17-item Hamilton Depression Rating Scale for Depression (HAM-D). Patients meeting the criteria were started on capsule fluoxetine, a selective serotonin reuptake inhibitor, in dose of 20-40 mg per day. Patients were periodically followed fortnightly and were reevaluated for therapeutic response using the HAM-D. A total of 30 patients (age = 20-40 years; mean age = 29 years; mean age of onset = 19 years; mean duration of illness = 11 months) were studied. The majority of cases were unmarried (64.2%) and educated till 5th class or above (70%). Twenty out of 30 (66%) patients met DSM-IV Diagnostic Criteria for Depression. Ten patients (33.3%) were found to have a comorbid problem of premature ejaculation, and two patients reported erectile dysfunction (6.6%). Patients showed statistically significant therapeutic response to fluoxetine. Depressive phenomenology meeting DSM-IV Diagnostic Criteria for Depression seems common in Dhat syndrome and responds to selective serotonin reuptake inhibitors along with regular counseling.

Socio‐cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India

Biomedical, anthropological and psychiatric frameworks have been used to research different elements of men's sexual health - sexually transmitted infections, psychosexual concerns and psychological distress - but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic-based survey of 366 symptomatic men who presented at rural private provider clinics. Men's urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12- items). Results revealed that local and traditional notions of health influenced men's symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non-infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51-4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive/sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.

Ejaculate Volume Is Seriously Underestimated When Semen Is Pipetted or Decanted Into Cylinders From the Collection Vessel

The total sperm count (number of spermatozoa per ejaculate) rather than sperm concentration (number of spermatozoa per unit volume of semen) is the more important semen variable related to fertility. It reflects testicular volume (Handelsman et al, 1984; Andersen et al, 2000; Behre et al, 2000), and thus is a measure of total testicular sperm output (MacLeod and Wang, 1979), which is directly related to the chances of pregnancy after coitus. The concentration of spermatozoa in the ejaculate, however, depends on the extent of dilution of epididymal spermatozoa by secretions of the prostate and seminal vesicles occurring at ejaculation and is therefore influenced by the secretory capacity of the accessory sex glands. This is an important distinction, for when comparing semen quality from older and younger men, sperm concentrations do not differ, yet semen volume is reduced in the older men, and so the total number of spermatozoa per ejaculate is lower in the older men (Ng et al, 2004; Nieschlag et al, 1982). The total number of spermatozoa per ejaculate is obtained by multiplying the concentration of spermatozoa by the semen volume. The latter is best measured by weighing (Eliasson, 2003), assuming a density of 1.0 g/mL (Auger et al, 1995; Jorgensen et al, 1997, 2001; Brazil et al, 2004), but alternative methods, such as collection into graduated cylinders (Behre et al, 2000), pipetting from the collection vessel (Mortimer 1994; Jorgensen et al, 1997), and pouring from the collection vessel into a graduated tube (Jorgensen et al, 1997), are in current practice. Two recent studies have found that pipetting semen from the collection vessel leads to an underestimation of about 0.5 mL (range 0.3–0.8 mL; Brazil et al, 2004; Iwamoto et al, 2006) compared with weighing, but no data are available about losses incurred when pouring semen into graduated cylinders. Because the area of contact with the sides of the collection vessel while decanting semen into a graduated cylinder is likely to be far larger than that during pipetting, retention within the vessel could be much larger, leading to a larger underestimation of volume with this method. In this study, new data are obtained on the loss of semen volume during decanting to a cylinder and previously published results on losses because of pipetting, and the density of semen is reanalyzed together with additional data.

Lessons for postgraduate trainees about Dhat syndrome

Dhat syndrome (“semen loss”-related psychological distress) is a culture-bound syndrome seen in the natives of Indian subcontinent, but it is prevalent in other cultures also. Its diagnosis and management issues need to be taught to postgraduates in their teaching program. This syndrome involves vague and multiple somatic and psychological complaints such as fatigue, listlessness, loss of appetite, lack of physical strength, poor concentration, forgetfulness and other vague somatic troubles. These symptoms are usually associated with an anxious and dysphoric mood state. These patients may also present with or without psychosexual dysfunction. The management of Dhat syndrome needs serious attention. The understanding of this condition by Modern Medicine fails to impress most of the patients, and the explanations and reassurances offered prove to be not of much use.

Dhat Syndrome as a Functional Somatic Syndrome: Developing a Sociosomatic Model

Dhat syndrome is a widely recognized condition from the Indian subcontinent with fatigue and preoccupation with semen loss as the main presenting symptoms. This condition has been considered to be a culture-bound syndrome, but little is known about its illness characteristics and similarities with other conditions with medically unexplained symptoms. In this paper we review the current research on dhat syndrome, discuss its similarities and differences with other functional somatic syndromes, and propose an integrated model that incorporates both psychological and sociocultural factors. Under stress, persons predisposed to amplification of somatic symptoms and health anxiety may focus attention on physiological changes such as turbidity of urine and tiredness, and misattribute them to loss of semen in the light of widely prevalent health beliefs. This attribution may then be confirmed by traditional views as well as by local practitioners subscribing to similar beliefs. The clinical and research implications of understanding this condition as a functional somatic syndrome, the presentation of which is significantly modified by culture, are discussed.

A comparative analysis of communication about sex, health and sexual health in India and South Africa: Implications for HIV prevention

This paper provides a comparative analysis of modes of dialogue, non‐verbal communication and embodied action relating to sex and health in two contrasting countries—India and South Africa—which have the world's two most heavily HIV‐affected populations (in terms of numbers of people living with HIV). Drawing on material derived from multiple studies, including ethnographic and other forms of qualitative and multi‐disciplinary research, the paper identifies commonalities as well as differences in communication relating to sex and sexual health in these diverse settings. The paper considers: first, how and by whom sex is and is not talked about, in public discourse and private conversation; second, how sexual intention and desire are communicated through indirect, non‐verbal means in everyday life; and third, how references to sexuality and the sexual body re‐enter within a more explicit set of indigenous discourses about health (rather than ‘sexual health’ per se), such as semen loss in India and womb ‘dirtiness’ in South Africa. The concluding section reflects on the implications of a comparative analysis such as this for current policy emphases on the importance of promoting verbal communication skills as part of ‘life skills’ for HIV prevention.

Spermatomania--the English response to Lallemand's disease

Spermatorrhoea, the involuntary loss of semen, is in Western medicine a complaint peculiar to the 19th century. The disease was championed by Professor Claude-Francois Lallemand, from Montpellier. In 1835, citing masturbation as a major cause, he wrote that the condition 'degrades man, poisons the happiness of his best days, and ravages society'. In England, for fifty years, doctors, patients and social commentators alike took a frenzied interest in the condition. It was only at the end of the century, when the likes of Sir James Paget questioned the very existence of spermatorrhoea, that it faded from prominence.

Dhat (semen loss) syndrome: a functional somatic syndrome of the Indian subcontinent?

Objective To study the illness characteristics of Dhat syndrome, which has been widely regarded as a culture-bound syndrome. Methods The sample was selected from a general hospital and included 29 patients with Dhat syndrome and 32 medical controls. Somatization Screening Index (SSI), Illness Behaviour Questionnaire (SIBQ), Somatosensory Amplification Scale (SAS), Whitley Index (WI) and Chalder Fatigue Scale were administered to both groups. Results Patients with Dhat syndrome scored significantly higher on all the measures except the SAS. Discussion The results indicate that patients with Dhat syndrome have significantly different illness beliefs and behaviours compared to controls and have similarities with other functional somatic syndromes (FSSs).

Dhat syndrome in relation to demographic characteristics

Background:The area of men's sexual health has been poorly understood, particularly with reference to South Asian cultures. The belief that losing semen is detrimental to health is a concept common to both Oriental and Occidental thinking.Aim:To estimate the number of patients with the dhat syndrome consulting different professionals in Lahore and to examine their demographic characteristics.Method:Seventy health professionals of various types were approached and asked to fill in a daily record form for all patients reporting at their clinics for a period of 1 month.Results:A total of 1777 patients were reported to attend the outpatient clinics of health professionals of various types over a period of 1 month. The majority of patients consulted hakims for professional help. Most of the patients were single, with a mean age of 24 years and had a monthly income of less than Rs 3000.Conclusion:These data have important implications for patients, professionals and researchers. The alarming number of people consulting various professionals to seek help for anxiety due to semen loss highlights the fact that research into and interventions for this neglected area of men's sexual health are urgently required.

The influence of centrifugation on quality and freezability of stallion semen

The aim of the present study was to investigate the influence of various centrifugation methods on sperm loss and quality of frozen-thawed semen. From at a total of 8 Warmblood stallions of the National Stud Farm in Avenches, 3 ejaculates each were collected and seminal plasma was removed using 3 different centrifugation regimes. In method I (reference method) centrifugation occurred by a speed of 600 x g during 10 minutes. In method II 1000 x g was used during 2 minutes while in method III centrifugation was performed by 2000 x g during 2 minutes. After centrifugation 90%, of the supernatant was removed and sperm loss calculated. After resuspension of the pellet with freezing medium, functional membrane integrity was evaluated by HOS-test and motility determined. In frozen-thawed semen motility, viability as well as functional membrane integrity (HOS-test) and acrosome status using chlortetracyclinassay (CTA) were assessed. Our results demonstrate that mean sperm loss (I, 1.9%; II, 8.7%; III, 3.7%) was significantly (P < 0.05) different between the three centrifugation regimes. Regarding semen quality of frozen-thawed semen, HOS in method III (52.1%) was significantly lower than in methods I (55.5%) and II (55.3%). Evaluation of the acrosome status by CTA showed that more than 70% of sperm cells were capacitated and 25% capacitated and acrosome reacted. From our results we conclude that sperm loss and functional membrane integrity (HOS-test) in frozen-thawed semen were significantly influenced by the centrifugation regime. Therefore, stallion semen should be centrifuged at 600 x g during 10 minutes before freezing in order to obtain low sperm loss and a good quality of frozen-thawed semen.

Beliefs concerning sexual health problems and treatment seeking among men in an Indian slum community

This study explores the sexual health problems and treatment-seeking behaviour of men in a Mumbai slum population. Men consider wet dreams, masturbation, early ejaculation, sexual weakness, and other semen-related issues as serious sexual health problems. Suppression of sexual desire was one of the major causes perceived by men for wet dreams, whereas masturbation was seen as the major cause for perceived early ejaculation and distortion in the shape of penis. Excessive loss of semen in any form, including through masturbation and frequent intercourse, was seen as causing most sexual health problems. These beliefs impact on subsequent behaviour, including treatment seeking. In this community-based study, about 45% of men reported to be currently suffering from one or more sexual health problems. One in every four who reported experiencing any problem sought treatment, mostly from the private sector that included a large number of unqualified and untrained providers. The present analysis stresses the importance of understanding these issues for sex education programmes and argues that traditional sexual health providers should be made an integral part of community-based STD/HIV/AIDS prevention efforts. Cette étude explore les problèmes de santé sexuelle et les comportements de recours aux soins chez des hommes d'un bidonville de Mumbai. Ces hommes perçoivent les pollutions nocturnes, la masturbation, l'éjaculation précoce, les défaillances sexuelles et toutes les préoccupations ayant rapport au sperme comme des problèmes sérieux de santé sexuelle. La disparition du désir sexuel est perçue par eux comme l'une des causes majeures des pollutions nocturnes, alors qu'ils considèrent la masturbation comme la cause principale de l'éjaculation précoce et des déformations du pénis. Une perte excessive de sperme, quelle qu'en soit la cause, de la masturbation aux rapports sexuels fréquents, est considérée comme à l'origine de la plupart des problèmes de santé sexuelle. Ces croyances influencent les comportements futurs, parmi lesquels ceux du recours aux soins. Dans cette étude menée dans un cadre communautaire, environ 45% des hommes ont signalé être confrontés, au moment des entretiens, à un ou à plus d'un problème de santé sexuelle. Parmi ces hommes, un sur quatre était en recherche de soins, pour la plupart dans le secteur privé qui comprend un nombre important de professionnels non formés et non qualifiés. Cette analyse souligne l'importance des programmes d'éducation sexuelle et soutient que les tradipraticiens en matière de santé sexuelle devraient faire partie intégrante des programmes de prévention des MST et du VIH/sida réalisés dans un cadre communautaire. En este estudio se examinan los problemas de salud sexual y el comportamiento de los hombres de una población de una barriada de Mumbai a la hora de buscar tratamiento. Los hombres creen que mojarse en la cama, la masturbación, la eyaculación precoz, la debilidad sexual y otros problemas relacionados con el semen son graves enfermedades de la salud sexual. Asimismo consideraban que la inhibición del deseo sexual era una de las principales causas de mojarse en la cama mientras que la masturbación era vista como la principal causa de eyaculación precoz y deformación del pene. Pensaban que la excesiva pérdida de semen, de cualquier forma, incluso a través de la masturbación y las relaciones frecuentes, era la causa de la mayoría de problemas sexuales. Estas creencias tienen un impacto en otros comportamientos, por ejemplo cuando hay que buscar un tratamiento. En este estudio basado en la comunidad analizada, aproximadamente el 45% de los hombres informaron que padecían uno o más problemas sexuales. Uno de cada cuatro hombres con problemas sexuales informó que buscaba un tratamiento, la mayor parte en el sector privado en el que se incluía un gran número de personal no cualificado sin formación alguna. El presente análisis subraya la importancia de programas de educación sexual y sugiere que el personal tradicional que se ocupa de la salud sexual forme parte integral del esfuerzo para prevenir el sida y otras enfermedades de transmisión sexual en la comunidad.

Addressing semen loss concerns: Towards culturally appropriate HIV/AIDS interventions in Gujarat, India

A situation analysis of sexual networking and sexual health in an industrial area of Gujarat, India, identified anxiety about masturbation and other semen loss concerns as major preoccupations among young men. This paper describes how the Deepak Charitable Trust addressed these concerns in their HIV prevention programme for young men aged 15 to 30. Flowcharts were used as participatory learning tools and to obtain data on the perceived consequences of masturbation, both before and after intervention activities. Research was also done on the relation between semen-related anxieties and sexual risk behaviour by DCT and two other NGOs among young men engaging in unsafe sexual behaviour. DCT advocates addressing masturbation and other semen loss concerns in all sexual health campaigns in South Asia, based on the magnitude of these concerns, their potential to confound syndromic management of STIs and their significance as an idiom of psychosocial distress. Masturbation and associated anxieties about sexual performance are seen as health issues and discussed as such by the programme. There is immediate identification among young men, whether or not they are already sexually active, and it provides an excellent entry point for sexual health and safer sex education. The community response to these efforts has been entirely positive.